AccountId: 011433970860
ContactId: 000edac5-0a5d-4190-9c42-ecbb3dc7692b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423380 ms
Total Talk Time (AGENT): 124284 ms
Total Talk Time (CUSTOMER): 191509 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/000edac5-0a5d-4190-9c42-ecbb3dc7692b_20250520T21:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling on behalf of dental office here to check on eligibility and benefits for a patient. Can you help me on that?
[AGENT][POSITIVE] Yes, I can help with eligibility and benefits. [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Mhm it's [PII] with the extension you can add is [PII].
[AGENT][NEUTRAL] OK, thank you. And the policy number for that patient?
[CUSTOMER][NEUTRAL] Uh, what I have here is 026091997.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, you can see uh Darby Kennedy, [PII].
[AGENT][NEUTRAL] show the policies effective [PII].
[AGENT][NEUTRAL] I can fax over a fax back that contains all of the benefits and list out all the codes that are covered in their frequencies, unless there's something you need to go over on the phone.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, if you're able to help me with this phone call, yeah.
[AGENT][NEUTRAL] OK, are you gonna need to check?
[CUSTOMER][NEUTRAL] OK, uh, so this one.
[AGENT][NEUTRAL] Cos
[CUSTOMER][NEUTRAL] Yeah, just a few things, uh, not the specific code, yeah, but I have some things like this will be a single coverage of family.
[AGENT][NEUTRAL] It's an individual plus spouse.
[CUSTOMER][NEUTRAL] OK, and the group name?
[AGENT][NEUTRAL] Uh her name is.
[AGENT][NEUTRAL] Management analysis and utilization.
[CUSTOMER][POSITIVE] OK, OK, that's good man.
[CUSTOMER][NEUTRAL] Analysis.
[CUSTOMER][NEUTRAL] Utilization.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the group number?
[AGENT][NEUTRAL] My group number is 70056.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] 56. And for this type of plan if need the, the plan does is provider here will be in or out of network and it's an open network policy?
[AGENT][NEUTRAL] They can see any network there or any provider they like. They do, they can use Carrington, but I don't have access to if you're network with them.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, Carrington, you said? OK.
[CUSTOMER][NEUTRAL] OK, Carrington and OK. And what will the claims sending address is gonna follow you?
[AGENT][NEUTRAL] Uh, claims mailing address is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII]. Got it. Thank you. And certainly for this plan, do you accept assignment of benefits for automatic providers as well, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. In the case of the benefits are exhausted in-network provider discount apply?
[AGENT][NEGATIVE] No, it would not.
[CUSTOMER][NEUTRAL] And for the non-covered services in-network provider discount applied.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And the last if the patient is not eligible for the service in network provider gonna apply.
[AGENT][NEGATIVE] No, it would not.
[CUSTOMER][NEUTRAL] Thank you. This plan runs on a calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Deductible and maximum please.
[AGENT][NEUTRAL] Not a guarantee of payment, basic outline of the policy 500.
[CUSTOMER][NEUTRAL] Uh, the max is 500.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, no deductibles?
[AGENT][NEUTRAL] Deductibles 50.
[CUSTOMER][NEUTRAL] OK. 50 and it applies to basic and major?
[AGENT][NEUTRAL] There's no major coverage. It applies to uh radiographs, FMX expenses, and basic expenses and basic restorative expenses.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, preventive and basics, OK, and, uh, anything has been used to now for the 50 or $500 maximum.
[AGENT][NEGATIVE] Nothing has been used.
[CUSTOMER][POSITIVE] Thank you. And orthodontics will be also non-co benefit, right as no majors here.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. And no waiting period, no missing tooth loss?
[AGENT][NEUTRAL] There's no waiting period. There is a missing tooth clause.
[CUSTOMER][NEUTRAL] Thank you. And uh what with the coinsurance for the preventive and basic?
[AGENT][NEUTRAL] Preventeddic pays 100%. Radiographs, SMX, Basic and Basic restorative pay 80% after a $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, at 50%. OK. And I just want to know the services like antidontics, periodontics, oral surgeries, and simple extractions. They will be in the basic at 50%.
[AGENT][NEUTRAL] No, those aren't covered. There's only
[AGENT][NEUTRAL] Um, simple extractions, the only thing that's covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and no frequency for the preventive like exam cleanings like that?
[AGENT][NEUTRAL] Uh, cleanings are once every 6 months, exams are 2 for 12 months, I wings once for 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] Fu mouth pano once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is it patient is eligible for fluoride.
[AGENT][NEUTRAL] No, it's to age [PII].
[CUSTOMER][NEUTRAL] OK, and uh I have a service as oral cancer screening 0431. Is it covered as preventive?
[AGENT][NEUTRAL] What was the code?
[CUSTOMER][NEUTRAL] 0431 oral cancer screening.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK, uh, P maintenance 4910, is it covered for preventive or base.
[AGENT][NEUTRAL] You, you need a list of codes, I can fax that to you. It it shows all of the codes that are.
[CUSTOMER][NEUTRAL] Uh, no, that's uh
[CUSTOMER][NEUTRAL] Not much, almost there.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEGATIVE] Uh, not covered. OK, OK, and no downgrades on this policy like for the fillings, right? Maybe not covered.
[AGENT][POSITIVE] Correct, no downgrades.
[CUSTOMER][NEUTRAL] OK, thank you and for the whole plan, the predetermination here would be mandatory or just recommend?
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][NEUTRAL] OK, so [PII], as I said, uh, only preventive and basic 150, that's all the information I need from you. So now just the reference number.
[AGENT][NEUTRAL] That's my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, so once again, thank you so much for your time. That's all you.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day. Bye-bye.